Healthcare Provider Details

I. General information

NPI: 1770911489
Provider Name (Legal Business Name): AMY FERSTENDIG L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 GRAND CENTRAL PKWY
JAMAICA NY
11432-5819
US

IV. Provider business mailing address

11213 68TH AVE
FOREST HILLS NY
11375-2937
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-2931
  • Fax:
Mailing address:
  • Phone: 917-952-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number027001-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: